A distance-based approach to rurality and remoteness in health: concept, methodology and correlates of a patient centred health services spatial accessibility index

Abstract

AIM: To develop a distance-based index of patients’ spatial accessibility to healthcare services as a quantifiable basis for analysing health services and health outcomes in urban, rural and remote locations. METHOD: A distance score was calculated based on each primary health organisation enrollee’s shortest distance to the nearest primary care facility and to the nearest secondary or tertiary hospital. The distance scores were then grouped into ten distance deciles (DDs). RESULTS: When these DDs are compared with Stats NZ’s urban-rural indicator, “small urban areas” fall mainly along with rural and remote areas into the two DDs (DD9 and DD10) based on the greatest distance scores. When compared with Stats NZ’s urban accessibility classification, the same two DDs correspond mainly to the most rural and remote areas. In both the North and South islands, 25% or more of enrollees in DD9 and DD10 are aged 60+. Of enrollees in DD10 in the North Island, 32% are Māori and 33% live in highly deprived areas (NZDep2013 deciles 9 and 10). CONCLUSION: The results provide an initial validation of the patient-centred health services spatial accessibility index as a measure of rurality and remoteness for analysis of health service provision and health outcomes.